Doctors say health plans block services

Physicians and nurses critical of managed care

July 29, 1999|By NEW YORK TIMES NEWS SERVICE

WASHINGTON -- A new survey shows widespread discontent among doctors and nurses about the quality of health care under managed care plans. A majority of doctors said some of their patients had been denied coverage for a health service they needed, whether a prescription drug, a diagnostic test or a treatment.

The survey was released in the midst of a struggle over patients' rights legislation on Capitol Hill, and was immediately criticized by spokesmen for health maintenance organizations and the insurance industry as flawed and exaggerated.

The survey, conducted for the Kaiser Family Foundation, a nonprofit health research group, was just as quickly praised by the American Medical Association and the American Nurses Association.

The Kaiser study was conducted with the Harvard School of Public Health and was administered by mail to a sample of 1,053 physicians and 768 nurses, between Feb. 11 and June 5. The findings for the doctors have a margin of sampling error of plus or minus 3 percentage points; for nurses, of plus or minus 4 percentage points.

Sixty-one percent of doctors said insurance plans denied cover- age for a prescription drug for one of their patients on a weekly or monthly basis. Thirty-one percent said they experienced denials of a hospital stay on a weekly or monthly basis, and 42 percent said they had experienced denials of diagnostic tests or procedures that often.

Between a third and two-thirds of the doctors said their most recent denial had resulted in a serious decline in the patient's health status, depending on the type of service denied.

Almost half of the nurses surveyed said they saw patients' health suffer because of decisions made by health plans. Thirty percent of the nurses -- and 26 percent of the doctors -- said they sometimes exaggerated the severity of a patient's condition to get care they thought was necessary.